Analysis in characteristics of pathogen infection and multidrug resistance in patients with perianal abscess
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摘要:目的
探讨肛周脓肿患者病原菌感染特点及耐药性。
方法对134例肛周脓肿患者(高位肛周脓肿60例，低位肛周脓肿74例)的脓液进行细菌培养分离鉴定病原菌。通过纸片扩散法进行药物敏感试验，对病原菌种分布、药敏结果和多重耐药菌的检出结果进行回顾性分析。
结果肛周脓肿治疗总有效率为96.27%, 其中治愈75例，好转54例，未愈5例。134份标本中，培养出138株病原菌，其中单一细菌生长为130份, 2种细菌生长为4份; 革兰氏阴性菌为124株(89.86%), 革兰氏阳性菌为14株(10.14%); 革兰氏阴性菌以大肠埃希氏菌、肺炎克雷伯菌为主，分别为89株(71.77%)和18株(14.52%); 革兰氏阳性菌则是以链球菌为主。革兰氏阴性菌对哌拉西林耐药率最高(74.65%), 对头孢他啶、环丙沙星、庆大霉素、头孢噻肟、头孢唑林的耐药率均超过50%; 大肠埃希菌对庆大霉素、头孢噻肟、头孢唑林、哌拉西林的耐药率高于60%。革兰氏阳性菌对万古霉素敏感率为100%, 对红霉素、四环素、克林霉素、环丙沙星、庆大霉素的耐药率均超过50%。检出产超广谱β-内酰胺酶(ESBLs)细菌12株，其中肺炎克雷伯菌2株，其余均为大肠埃希菌，多重耐药菌发生率为8.70%。
结论肛周脓肿患者以革兰氏阴性菌感染为主，病原菌以大肠埃希氏菌、肺炎克雷伯菌为主。为降低多重耐药菌感染发生率，临床医师应按照患者肛周脓肿药敏试验结果合理使用抗菌药物。
Abstract:ObjectiveTo explore the characteristics of pathogen infection and drug resistance in patients with perianal abscess.
MethodsBacteria were isolated and identified from the pus of 134 patients with perianal abscess (60 cases with high perianal abscess and 74 cases with low perianal abscess). Drug sensitivity test was performed by kirby-bauer, and the distribution of pathogenic bacteria, the results of drug sensitivity test and the detection results of multidrug resistant bacteria were analyzed retrospectively.
ResultsThe total effective rate of perianal abscess was 96.27%, 75 cases were cured, 54 cases were improved, and 5 cases were not cured. Among 134 specimens, 138 strains of pathogenic bacteria were cultured, there were 130 samples of single bacterial growth and 4 samples of two kinds of bacterial growth; there were 124 strains (89.86%) of Gram-negative bacteria and 14 strains (10.14%) of Gram-positive bacteria; among Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae were the main types, with 89 strains (71.77%) and 18 strains (14.52%) respectively; among Gram-positive bacteria, Streptococcus was the main type. Among Gram-negative bacteria, piperacillin had the highest resistance rate (74.65%), and the resistance rates of ceftazidime, ciprofloxacin, gentamicin, cefotaxime and cefazolin were all over 50%; the resistance rate of Escherichia coli to gentamicin, cefotaxime, cefazolin and piperacillin was higher than 60%. Among Gram-positive bacteria, the sensitivity rate of vancomycin was 100%, and its resistance rate to erythromycin, tetracycline, clindamycin, ciprofloxacin, gentamicin was higher than 50%.A total of 12 strains of bacteria producing extended-spectrum β-lactamases (ESBLs) were detected, including 2 strains of Klebsiella pneumoniae and 10 strains of Escherichia coli, and the incidence of multidrug resistant bacteria was 8.70%.
ConclusionPatients with perianal abscess are mainly infected by Gram-negative bacteria, and Escherichia coli and Klebsiella pneumoniae are the main types. In order to reduce the infection of multidrug resistant bacteria, antibiotics should be used reasonably according to the results of drug sensitivity test of perianal abscess.
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表 1 138株病原菌种类[n(%)]
病原菌 分布情况 大肠埃希菌 89(64.49) 肺炎克雷伯菌 18(13.04) 奇异变形菌 8(5.80) 产气肠杆菌 4(2.90) 金黄色葡萄球菌 4(2.90) 草绿色链球菌 3(2.17) 肺炎链球菌 3(2.17) 化脓性链球菌 3(2.17) 铜绿假单胞菌 3(2.17) 阴沟肠杆菌 2(1.46) 粪肠球菌 1(0.73) 合计 138(100.00) 
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表 2 革兰氏阴性菌对抗生素的耐药率
% 抗菌药物 革兰氏阴性菌(n=124) 大肠埃希菌(n=89) 肺炎克雷伯菌(n=18) 哌拉西林 74.65 68.43 — 头孢唑林 68.35 65.15 28.67 头孢噻肟 65.87 63.13 28.98 庆大霉素 58.98 60.45 24.87 环丙沙星 55.76 58.87 23.87 头孢他啶 51.23 48.76 16.87 阿莫西林克拉维酸钾 25.67 23.65 12.54 氨曲南 16.23 23.65 12.23 哌拉西林他唑巴坦 4.76 2.45 — 亚胺培南 0.78 0 0 美罗培南 0 0 0
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